Provider Demographics
NPI:1275358830
Name:BLANCO, YAHAYRA ESMERALDA
Entity type:Individual
Prefix:
First Name:YAHAYRA
Middle Name:ESMERALDA
Last Name:BLANCO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3050 SATURN ST STE 102
Mailing Address - Street 2:
Mailing Address - City:BREA
Mailing Address - State:CA
Mailing Address - Zip Code:92821-6281
Mailing Address - Country:US
Mailing Address - Phone:657-296-5375
Mailing Address - Fax:
Practice Address - Street 1:701 E PINEHURST AVE
Practice Address - Street 2:
Practice Address - City:LA HABRA
Practice Address - State:CA
Practice Address - Zip Code:90631-3921
Practice Address - Country:US
Practice Address - Phone:657-255-0047
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-19
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician